Summer Skin Fitness III: Treatments for Visible Leg Veins

Insights from Dr. Lisa Ginn

The end of summer is perfect timing for the last topic in my series on Summer Skin Fitness. I started the summer with colorblind laser therapies and then described how you can manage pesky conditions that are made worse by the summer sun. Now summer is nearly over, which makes it the perfect time for treating visible leg veins. In this post I explain 3 different types of visible and bothersome leg veins, treatments that are available, and why this is a good time of year to address them.

With all the advances and cosmetic therapies available to women nowadays it amazes me how treating these pesky, unsightly veins remains near the top of the list for women who want a cosmetic treatment. Why is this? There are a couple of factors.

Between the ages of 20 and 24, 8% of women and 1% of men have visible leg veins. By the time we reach age 40-49 that number jumps to 41% of women and 24% of men. That’s nearly half the population of women and one-quarter the population of men in that age range!

Actually when you look at the disease process of visible leg veins, it can start as early as the teenage years. There are three risk factors for the disease. These are:

Genetics. If your parents have visible leg veins you are twice as likely to have them.

Lifestyle. Your risk is greater if you have a job where you sit or stand for extended periods versus someone who can move around a lot.

Visible leg veins have a range of appearances. The mildest veins are fine, red, and threadlike; they are usually called spider veins because of their resemblance to a spider’s web. On the other end are the larger, bluish-green ropey veins that you can feel when you run your hand over them; these tend to be true varicose veins. In the middle are reticular veins. Larger than spider veins and smaller than varicose, these are visible veins that may be headed toward becoming true varicose veins.

Veins are part of your circulatory system. Arteries have muscles in their walls that pump blood away from the heart. Veins, on the other hand, have valves but no muscle. I describe these valves as a working like a trap door. In a properly functioning vein, the blood pools. The pressure of the pooling blood pushes the trap door (or valve) open, the blood rushes through and the door slams shut. Visible leg veins have a trap door that has a little delay instead of immediately slamming shut. In true varicose veins the trap door or valve won’t close all the way but quivers a little bit. As a result the blood pools and doesn’t flow normally. The blood can back up into another vein causing a reticular vein. Hormones and pregnancy can also cause reticular veins.

Symptoms of visible leg veins can be cosmetically inconvenient or cause real pain and leg restlessness during the day and night. The disease can also progress from being a cosmetic issue to a real medical problem. But not everyone who gets spider veins will develop varicose veins.

In the past those with the disease had to suffer in silence, as treatments were very limited. The side effects left extensive scarring after the surgery. The only reason people would elect to undergo the surgery was for the medical outcome – relief from the leg discomfort outweighed the scarring. These days there is good news for everyone! There are various types of treatments available that can treat all types of visible leg veins regardless of the size or severity of the veins. Most treatments have little to no downtime and there is little risk of scarring and other side effects. You just have to make sure you get the correct treatment for your veins.

Here is how I describe visible leg veins to my patients. Imagine a tree. True varicose veins represent the trunk of the tree. Little red spider veins are the outermost branches. Reticular veins are like the main or primary branches. Treatment depends on where you have the disease. What I mean by this is if you have varicose veins – the trunk – it won’t help to just treat the branches.

Any decisions I make about how to treat a particular vein starts with taking a detailed patient history. If a patient with greenish-blue veins says they have a family history of varicose veins and achy legs, then it’s probably varicose. If, however, a patient has greenish-blue small veins that run across the leg instead of up and down the leg, and I’m not sure I can feel them, the veins are probably reticular. In either case I recommend an adequate medical workup that uses a Doppler to see the blood flow. A Doppler is similar to ultrasound and allows me to determine if the visible vein is cosmetic or medical.

If it’s determined that a patient only has spider veins and does not have any varicose veins, then hands down the best treatment is sclerotherapy. This is when a certain type of liquid is injected into the vein with the smallest of needles. The liquid pushes blood out of the vein. The liquid then dissolves down and the vein collapses on itself. Sclerotherapy typically requires two to four sessions, and although it cannot remove 100% of all spider veins, it can result in a dramatic improvement in appearance.

For reticular veins there are new solutions that are detergents. These solutions are mixed before injecting. The injection is just like sclerotherapy. The foaming detergent pushes the blood out and foams down, and the vein walls collapse on themselves. This treatment also tends to require two to four sessions.

Laser therapy is another option where no needles are involved. With laser therapy there are some limitations in the skin tone that you can treat. The darker the skin, the harder it is to treat effectively. The laser is extremely expensive, quite uncomfortable, and requires multiple sessions. For these reasons I prefer the sclerotherapy.

True varicose veins require a different approach. There is a surgical procedure called VNUS Closure that has been available for about 10 years now and is performed right in the doctor’s office. It uses imaging so a physician can see the inside of the vein. Patients are literally up and walking around the next day. Scars are minimal.

Earlier I mentioned that late summer/early autumn is a good time for a visible leg vein treatment. That’s because I recommend that all my leg vein patients wear compression hose. These fit like thick tights and create a little bit of pressure to keep the treated veins shut down and prevent them from filling back up with blood.

Compression hose are not a popular article of clothing during the hot summer months. But in autumn and winter they look just like regular tights. They even come in different colors. Another reason to favor autumn as an ideal treatment time is because occasionally a patient will develop temporary dark spots at the injection sites. With an early autumn treatment, they will have all of autumn and winter for the spots to fade away. Then my patient can emerge with smooth, evenly colored legs for spring and summer’s lighter wardrobes

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